Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship?

Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies. This study is based, in part, on the first author's dissertation. A previous version of this paper was presented at the Society for Social Work and Research Annual Conference held in January 2005 in New Orleans, Louisiana. The following grants provided funding for this study: R01DA11027 and 3T32MH014623-22S1.     

The Impact of Child Abuse History, PTSD Symptoms, and Anger Arousal on Dating Violence Perpetration Among College Women

Preliminary research suggests that child abuse is indirectly associated with female-perpetrated intimate partner violence via posttraumatic stress disorder (PTSD) symptoms and anger. To date, however, no known studies have investigated these relationships for physical and psychological dating violence within a female college sample. Therefore, the purpose of the current study was to examine the impact of child abuse history, PTSD symptoms, and anger arousal on female-perpetrated physical and psychological dating violence. Female undergraduates (N = 496) completed measures of child abuse, PTSD symptoms, anger arousal, and dating violence perpetration as part of a larger trauma and violence study. Results indicated that child abuse directly predicted female-perpetrated physical and psychological dating violence and indirectly impacted female-perpetrated physical and psychological dating violence via PTSD symptoms and anger arousal. The direct relationships between PTSD symptoms and female-perpetrated physical and psychological dating violence were nonsignificant after controlling for the effect of anger arousal.     

Partner's stake in conformity and abused wives' psychological trauma

This study investigates the potential buffering effect of help-seeking in the association between intimate partner assault and women's psychological trauma, and how this, in turn, may depend on the partner's stake in conformity. The sample consists of 374 women reporting the experience of domestic violence from a current intimate partner, drawn from the larger survey Violence and Threats of Violence Against Women and Men in the United States, 1994-1996. Help-seeking did not appear to buffer the impact of assault severity, contrary to expectation. However, the partner's stake in conformity did condition the effect of his or her having been arrested. Victims had higher levels of posttraumatic stress disorder (PTSD) when police arrested partners of average or below-average stake in conformity. But victims of partners characterized by higher than average stake in conformity did not show elevated PTSD due to their partners having been arrested. On the other hand, PTSD was higher among women experiencing more emotional abuse from the partner.     

Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis

This article reviews literature on the prevalence of mental health problems among women with a history of intimate partner violence. The weighted mean prevalence of mental health problems among battered women was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. These were typically inconsistent across studies. Weighted mean odds ratios representing associations of these problems with violence ranged from 3.55 to 5.62, and were typically consistent across studies. Variability was accounted for by differences in sampling frames. Dose-response relationships of violence to depression and PTSD were observed. Although research has not addressed many criteria for causal inferences, the existing research is consistent with the hypothesis that intimate partner violence increases risk for mental health problems. The appropriate way to conceptualize these problems deserves careful attention.     

Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence

This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.     

Unemployment among women: examining the relationship of physical and psychological intimate partner violence and posttraumatic stress disorder

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and women's workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.     

Intimate Partner Violence in Extremely Poor Women: Longitudinal Patterns and Risk Markers

Despite high revalence rates of intimate partner violence in the lives of extremely poor women with dependent children, few studies have investigated the patterns of violence that occur over time, and the characteristics of women that serve as risk markers for partner violence. This paper describes patterns of domestic violence longitudinally and uses multivariate analyses to delineate childhood and adult risk markers for recent intimate partner violence in this population of women. Analyses draw upon a sample of 436 homeless and extremely poor housed mothers receiving welfare, in a mid-sized city in Massachusetts with a large Hispanic population of Puerto Rican descent and relatively fewer Blacks. We found that among women with complete longitudinal data (N=280), almost two-thirds experienced intimate partner violence at some point during their adult life by the end of study follow-up, and that the abuse before and after the baseline interview was episodic and limited over time. To examine the role of individual women's factors, while controlling for partner characteristics, we used baseline data on women who had been partnered during the past year (N=336). Among childhood predictors, we found that sexual molestation contributed most significantly to adult intimate partner violence that occurred during the past year prior to the baseline interview. Adult risk markers included inadequate emotional support from non-professionals, poor self-esteem, and a partner with substance abuse problems. Having a partner with poor work history was another independent predictor of recent abuse. Ethnicity did not significantly predict whether women were abused or not during the past year, contrary to other findings reported in the literature.     

Beyond PTSD: mental health consequences of violence against women: a response to Briere and Jordan

This article proposes that we move beyond posttraumatic stress disorder (PTSD) in our conceptualization of traumatic stress responses of victimized women exposed to serial forms of unrelenting violence, such as intimate partner violence and stalking. It is argued that the traditional PTSD framework is ill fitting in the context of some forms of violence against women (VAW), and these limits have consequences for developing appropriate interventions for some victimized women. The article further suggests going beyond PTSD by developing a more nuanced understanding of the ways in which PTSD and other mental health symptoms contribute to the vast array of deleterious personal, societal, and economic costs of VAW.     

Top 10 greatest "hits": important findings and future directions for intimate partner violence research

In this article, the author highlights her choice of the 10 most important recent findings from the intimate partner violence research literature, which include (a) the creation of the Conflict Tactics Scale; (b) the finding that violent acts are most often perpetrated by intimates; (c) a series of findings that indicate that women also engage in intimate partner violence; (d) the finding that intimate partner violence typically evolves out of relationship dissatisfaction; (e) the finding that there are different subtypes of domestically violent men; (f) physiological measures that have added to our knowledge of intimate partner violence; (g) the evolving intergenerational transmission of violence theory; (h) the finding that verbal abuse, neglect, and psychological abuse need to be studied alongside physical violence; (i) research on leaving abusive relationships that may inform policy about sheltering battered women; and (j) the finding that alcohol plays an important role in the production of intimate partner violence. In the conclusion, the author describes a dyadic cycle of violence that may characterize some abusive couples. She also argues for a multimodal theory that links findings obtained from individual, relationship, intergenerational, gender-specific, and cultural perspectives.     

Posttraumatic Stress Disorder and Depression in Battered Women: The Mediating Role of Learned Helplessness

Learned helplessness (LH) may mediate the link between violence exposure and mental disorders in battered women. This study evaluated the contribution of LH to Posttraumatic Stress Disorder (PTSD) and major depression (MDD) in women with prolonged exposure to partner violence in 101 residents of shelters for battered women in Israel. DSM-IV axis-I disorders were assessed by a structured clinical interview. Self-report questionnaires evaluated exposure to violence, symptoms of PTSD and depression, LH, history of child abuse, SES and the extent of male-dominance and prejudice against women in the participants prior socialization background. LH significantly mediated the effect of violence on PTSD and depression symptoms. Male-dominated background contributed to LH. Thus, LH may increase the risk of mental disorders in battered women and should be addressed in interventions designed to reduce the burden of mental illness in this population.     

Social Support and Self-Esteem Moderate the Relation Between Intimate Partner Violence and Depression and Anxiety Symptoms Among Portuguese Women

Psychological distress and alcohol abuse have been linked to intimate partner violence (IPV). However, not all victims develop these problems. This study analyses the impact of IPV severity, social support, and self-esteem on depressive and anxiety symptoms as well as on alcohol abuse, and tests social and personal resources as moderators of the abuse-psychological distress-substance abuse link in a sample of Portuguese women including victims and non-victims of IPV (N?=?209). IPV severity contributed significantly to depression and anxiety symptoms as well as to alcohol abuse, after controlling for socio-demographic factors. Both social support and self-esteem were found to moderate the relation between IPV and depression and anxiety symptoms. However, moderation did not occur for the association between IPV and alcohol abuse. This study shows the impact of IPV on mental health and on alcohol abuse, and highlights the need to design effective interventions that promote social and personal resources in victimized women.     

Risk for Revictimization of Intimate Partner Violence by Multiple Partners: a Systematic Review

Are victims of intimate partner violence (IPV) by multiple partners (MP) different from victims of IPV by one partner? Are there different victim-related risk factors for IPV by MP? This systematic literature review identified seven empirical studies that related to these issues. The review findings indicated that (1) empirical research on IPV by MP appears to be scarce, with only limited recent development; (2) there were significant differences between women who had been subjected to IPV in a single relationship and women with IPV by MP; (3) IPV by MP was significantly associated with childhood domestic trauma, drug abuse, IPV characteristics, and attachment style; (4) regarding PTSD and personality disorders, the results were mixed and inconclusive; and (5) depression did not appear as a salient risk factor for IPV by MP. Interpretations must be made cautiously because of the wide diversity in measurement approaches. It is important that service personnel and researchers attend with increased awareness to women with IPV by MP.     

Psychopathology in women arrested for domestic violence

This study examined the prevalence of psychopathology among women arrested for violence and whether the experience of intimate partner violence (IPV) was associated with Axis I psychopathology. Women who were arrested for domestic violence perpetration and court referred to violence intervention programs (N= 103) completed measures of IPV victimization, perpetration, and psychopathology. Results revealed high rates of posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder (GAD), panic disorder, substance use disorders, borderline personality disorder, and antisocial personality disorder. Violence victimization was significantly associated with symptoms of psychopathology. Logistic regression analyses showed that sexual and psychological abuse by partners were associated with the presence of PTSD, depression, and GAD diagnoses. Results highlight the potential importance of the role of violence victimization in psychopathology. Results suggest that Axis I and Axis II psychopathology should routinely be assessed as part of violence intervention programs for women and that intervention programs could be improved by offering adjunct or integrated mental health treatment.     

Symptom Patterns among Youth Exposed to Intimate Partner Violence

Children and adolescents exposed to intimate partner violence display a broad range of symptoms. We sought to differentiate symptom patterns and predictors of these patterns using a person-oriented approach. Previous cluster analysis research of exposed youth was extended to include youth PTSD symptoms and trauma history. Participants were 74 mothers who had received a police call for domestic violence, and who had a child between 2 and 17 years old. Cluster analysis was used to identify four symptom patterns among exposed youth: Typical, Asymptomatic, General Distress, and Acute PTSD. These patterns were replicated in separate cluster analyses with younger and older participants. Symptom patterns were differentiated by maternal distress, maternal aggression, and youth trauma history, but not by male partner aggression. Implications for assessment and treatment of youth exposed to intimate partner violence, and suggestions for further research, are discussed.     

Gender differences in risk for intimate partner violence among South African adults

Despite a high prevalence of intimate partner violence in South Africa, few epidemiological studies have assessed individual risk factors and differential vulnerability by gender. This study seeks to analyze gender differences in risk for intimate partner violence victimization and perpetration according to childhood and adult risk factors in a national sample of South African men and women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the authors examine data from 1,715 currently married or cohabiting adults on reporting of intimate partner violence. Our analysis include (a) demographic factors, (b) early life risk factors (including exposure to childhood physical abuse, witnessing parental violence, parental closeness, and early onset DSM-IV disorders), and (c) adult risk factors (including experiencing the death of a child and episodes of DSM-IV disorders after age 20). Although prevalence rates of intimate partner violence are high among both genders, women are significantly more likely than men to report being victimized (29.3% vs. 20.9%). Rates of perpetrating violence are similar for women and men (25.2% and 26.5%, respectively). Men are more likely to report predictive factors for perpetration, whereas women are more likely to report predictors for victimization. Common risk factors among men and women reporting perpetration include exposure to childhood physical abuse, witnessing parental violence, and adult onset alcohol abuse/dependence. However, risk factors in male perpetrators are more likely to include cohabitation, low income, and early and adult-onset mood disorders, whereas risk factors in female perpetrators include low educational attainment and early onset alcohol abuse/dependence. The single common risk factor for male and female victims of partner violence is witnessing parental violence. Additional risk factors for male victims are low income and lack of closeness to a primary female caregiver, whereas additional risk factors for female victims are low educational attainment, childhood physical abuse, and adult onset alcohol abuse/dependence and intermittent explosive disorder. Intimate partner violence is a significant public health issue in South Africa, strongly linked to intergenerational cycling of violence and risk exposure across the life course. These findings indicate that gender differences in risk and common predictive factors, such as alcohol abuse and exposure to childhood violence, should inform the design of future violence-prevention programs and policies.     

Differences in female and male victims and perpetrators of partner violence with respect to WEB scores

Measurements of intimate partner violence (IPV) based on acts of violence have repeatedly found substantial bilateral violence between intimates. However, the context of this violence is not well defined by acts alone. The objective of this research was to compare differences in women and men within each IPV status category (victim, perpetrator, and both) with respect to levels of battering as defined by their scores on the Women's Experience With Battering Scale (WEB), which asks gender-neutral questions about the abuse of power and control and fear in an intimate relationship. In our study, women disclosed higher levels of battering on the WEB, despite IPV status (victimization or both victimization and perpetration). In addition, female IPV victims were 5 times more likely than their male counterparts to disclose high rates of battering on the WEB. Depressive symptoms, symptoms of posttraumatic stress disorder, African American race, and IPV victimization were independently associated with higher WEB scores.     

African American Women’s Readiness to Change Abusive Relationships

This study explores 178 low-income, abused African American women’s readiness to change abusive relationships and achieve safety. We explore stages of change using Prochaska and DiClemente’s transtheoretical model (TM; Precontemplation, Contemplation, Action, Preparation, and Maintenance). Results reveal that: for abused women, the stages fall along a continuum (versus discreet and linear stages); abused women are primarily in the Contemplation stage; and multiple factors (perception of current abuse, number of children in her home, symptoms of general anxiety and posttraumatic stress disorder [PTSD], substance use, spiritual well-being, self-esteem, and social support) affect women’s total readiness to change intimate partner violence (IPV). Current IPV, anxiety, PTSD, substance abuse, and spirituality were positively correlated with readiness to change, and children in the home and self-esteem were negatively correlated with readiness to change. Multiple regression analysis revealed that PTSD and spiritual well-being are positive predictors of readiness to change. Findings contribute to the growing body of literature supporting the TM as applied to IPV. Results are discussed in terms of applicability to interventionists, policy makers, and community leaders as they consider the plight of abused women and their efforts towards violence-free relationships.     

A Cross-Cultural Assessment of Posttrauma Reactions Among Malaysian and US Women Reporting Partner Abuse

Information on partner abuse in women from non-Western cultures and resulting psychological morbidity are scant. The present study examined these issues among women who experienced partner violence and sought refuge at a domestic violence shelter in Malaysia. These women completed a semi-structured interview and standardized measures to assess posttrauma morbidity. Responses by Malaysian shelter residents were compared with a sample of US women who also reported partner violence. The majority of women in both samples reported severe levels of distress and met criteria for posttraumatic stress disorder (PTSD). These findings suggest that psychological problems that women face after partner abuse may be similar in many respects, despite political, geographical, or cultural differences.     

Suicidal behavior among low-income, African American female victims of intimate terrorism and situational couple violence

This study examined risk of suicidal behavior among low-income, African American women (N = 369) in three types of male intimate relationships- intimate terrorism (IT) (i.e., physical violence used within a general pattern of coercive control), situational couple violence (SCV; i.e., episodic physical violence that is not part of a general pattern of coercive control), and nonviolent (NV; i.e., no physical violence). IT victims had more than double the odds of suicidal behavior compared to SCV victims and this association remained significant after controlling for physical violence severity, depression symptoms, and alcohol and drug abuse. Risk of suicidal behavior was not significantly different for SCV victims compared to women in NV relationships. Findings emphasize the need for researchers and practitioners to distinguish between types of male partner violence when examining its context and consequences for female victims.     

Psychological abuse and posttraumatic stress symptoms in college students

Research suggests that among college students, physical and sexual abuse in intimate relationships are associated with posttraumatic stress. Psychological abuse occurs in intimate relationships among college students, and though there is evidence that such abuse has a negative emotional impact, posttraumatic stress has not been extensively researched as an outcome in this population. The purpose of this study is to determine the associations of past-year psychological abuse with posttraumatic stress symptoms while controlling for other types of past-year relationship abuse and lifetime trauma history. The sample consists of 191 college men and women (81.7% women and 89.5% White). Linear regression analyses demonstrate that trauma history, but not past year relationship violence, is a significant predictor of PTSD symptom severity for women, and neither set of variables significantly predicts PTSD symptom severity for men. Implications for future research are discussed.